Diagnostic test for alzheimer&#39;s disease

ABSTRACT

A method for the diagnosis of Alzheimer&#39;s disease (AD) in a patient, comprising the steps of:  
     (1) providing a sample of an appropriate body fluid from said patient, and  
     (2) detecting the presence of BuChE with an altered glycosylation pattern in said sample.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] The present application is based upon and claims the priority ofU.S. Provisional Patent Application Ser. No. 60/195,231 filed Apr. 7,2000 which is incorporated herein by reference.

TECHNICAL FIELD

[0002] The present invention is concerned with a diagnostic test forAlzheimer's disease.

BACKGROUND ART

[0003] Alzheimer's disease (AD) is a common progressive dementiainvolving loss of memory and higher cognitive function. The disease ischaracterized by the presence of amyloid deposits in the brains ofsufferers. These deposits are found both extracellularly (amyloidplaques) and intracellularly (neurofibrillary tangles). The principalconstituent of amyloid plaques is the amyloid protein (Aβ) which isproduced by proteolytic cleavage for the amyloid protein precursor (APP)(Evin et al., 1994). The principal constituent of neurofibrillarytangles is the cytoskeletal protein tau (Kosik, 1992).

[0004] One of the characteristic neurochemical changes observed in AD isthe loss of acetylcholinesterase (AChE) and choline acetyltransferaseactivity in regions of the brain such as the cortex, hippocampus,amygdala and nucleus basalis (Whitehouse et al., 1981, 1982; Struble etal., 1982; Mesulam and Geula, 1988). The loss of cholinergic structureand markers correlates with the number of plaque and tangle lesionspresent, as well as with the clinical severity of the disease (Perry etal., 1978; Wilcock et al., 1982; Neary et al., 1986; Perry, 1986). Thisloss of AChE is accompanied by an increase in butyrylcholinesterase(BuChE) (Atack et al., 1986).

[0005] Accurate diagnosis of AD during life is essential. However,clinical evaluation is at best only about 80% accurate. Therefore, thereis a need to identify specific biochemical markers of AD. So far,analysis of blood or cerebrospinal fluid (CSF) has not yielded abiochemical marker of sufficient diagnostic value (Blass et al., 1998),although detectable differences are reported in the levels of certainproteins (Motter et al., 1995).

[0006] The assay of levels of AChE and BuChE activity in the blood andthe cerebrospinal fluid (CSF) have been proposed as an ante mortemdiagnostic test for AD. However, no consensus has been reached as towhether the levels of AChE and BuChE are consistently affected in thesetissues. The level of serum or plasma AChE has been reported to beincreased (Perry et al., 1982; Atack et al., 1985), decreased (Nakano etal., 1986; Yamamoto et al., 1990) or unchanged (St. Clair et al., 1986;Sirvio et al., 1989) in AD patients. The level of erythrocyte AChE hasbeen reported as either unaffected (Atack et al., 1985; Perry et al.,1982) or decreased Chipperfield et al., 1981). The level of AChEactivity in the CSF of AD patients has been reported to be decreased(most recently by Appleyard and McDonald, 1992; Shen et al., 1993) orunchanged (most recently by Appleyard et al., 1987; Ruberg et al.,1987).

[0007] AChE and BuChE have been shown to exist as up to six differentmolecular isoforms, three of which are the monomeric (G1), dimeric (G2)and tetrameric (G4) isoforms (Massoulié et al., 1993). The relativeproportion of the different isoforms of AChE and BuChE are markedlyaffected in AD, with a decrease in the G4 isoform of AChE in theparietal cortex (Atack et al., 1983), and an increase in the G1 isoformof AChE (Arendt et al., 1992). Similar changes have been identified inother AD brain regions including Brodman areas 9, 10, 11, 21 and 40, aswell as the amygdala (Fishman et al., 1986). Asymmetric collagen-tailedisoforms (A12) are increased by up to 400% in Brodman area 21, althoughthey represent only a trace amount of the total AChE in the human brain(Younkin et al., 1986).

[0008] However, to date changes in AChE and BuChE expression and isoformdistribution have not been found to be of sufficient sensitivity orspecificity to be useful diagnostic markers of AD.

DISCLOSURE OF THE INVENTION

[0009] There remains a need for a diagnostic test for AD based on abiochemical analysis of body fluids such as blood or CSF. The presentinvention provides such a test on the basis that thebutyrylcholinesterase (BuChE) of AD patients shows a differentglycosylation pattern to the BuChE of non-AD groups.

[0010] According to a first aspect of the present invention there isprovided a method for the diagnosis of Alzheimer's disease (AD) in apatient, comprising the steps of:

[0011] (1) providing a sample of an appropriate body fluid from saidpatient, and

[0012] (2) detecting the presence of BuChE with an altered glycosylationpattern in said sample.

[0013] In one embodiment of the invention the relative proportion ofBuChE with a specific glycosylation pattern to the total BuChE ismeasured.

[0014] Measurement of the relative proportion of the isoforms of BuChEwith a specific glycosylation pattern to the total BuChE may be carriedout in any convenient manner, for example, by using biochemical analysistechniques such as HPLC and mass spectrometry, or immunologicaltechniques such as ELISA or, assays. However, a particularly preferredmeans of measuring the relative proportions of the isoforms of BuChEinvolves a lectin-binding analysis.

[0015] It has been established that on average approximately 93.6% ofthe BuChE in the CSF of AD patients binds to Concanavalin (Con A).Accordingly, in a particularly preferred embodiment of the invention, inorder to detect the presence of BuChE with a to specific glycosylationpattern in the sample, the binding of BuChE to Con A is determined. Thepercentage of BuChE bound to Con A is characteristic of the proportionof BuChE with the specific glycosylation pattern.

[0016] Also, it is particularly useful to measure the activity ofunbound BuChE in each experiment, by determining the amount of BuChEunbound to Con A relative to the total BuChE in the sample.

[0017] In another embodiment of the present invention, it isparticularly advantageous to compare the ratio of AChE that binds to ConA with the AChE that binds to wheat germ agglutinin (WGA), hereinafterreferred to as the C/W ratio, versus the percentage of BuChE unbound toCon A. The ratio is characteristic of the different glycosylationpatterns of AChE. By plotting the C/W ratio versus the percentage BuChEunbound to Con A, the separation of patients diagnosed with AD ascompared with non-AD becomes evident when viewing such a plot.

[0018] Approximately 75-95% of the AChE in the CSF of AD patients bindto Concanavalin (Con A) or wheat germ agglutinin (WGA) but withdifferent specificity to each. For patients with AD, the C/W ratio istypically above 0.95 and the percentage of BuChE unbound to Con Arelative to the total BuChE is at least about eight percent (8%).

[0019] In an alternative embodiment of the invention there is provided amonoclonal antibody specific for BuChE with an altered glycosylationpattern used to detect its presence.

[0020] The body fluid analysed can be cerebrospinal fluid (CSF), bloodor blood plasma. Advantageously, when said body fluid is blood, bloodplasma is prepared from the blood for analysis.

[0021] According to a further aspect of the present invention there isprovided an abnormal isoform of BuChE with an altered pattern ofglycosylation and characterised in that it has a relatively lesseraffinity for Concanavalin (Con A) than BuChE with an unalteredglycosylation pattern.

[0022] According to another aspect of the present invention there isprovided an abnormal isoform of BuChE with an altered glycosylationpattern and characterised in that it has a relatively lesser affinityfor Con A than BuChE with an altered glycosylation pattern.

BRIEF DESCRIPTION OF THE DRAWINGS

[0023]FIG. 1 shows the correlation between the level of AChE and BChE incerebrospinal fluid. (Black squares=controls. Open circles=AD.) Thisfigure shows that there is a positive correlation in the levels of AChEand BChE suggesting that similar biochemical mechanisms may underly thedecrease in activity of both enzymes in AD CSF.

[0024]FIG. 2 is a plot of the AChE C/W ratio vs. the percentage (%) BChEunbound to Con. A. This figure shows that there is no clear correlationbetween these analytes. This figure also shows that by combining bothmeasures, almost complete separation can be achieved between the AD andcontrol groups.

[0025]FIG. 3 is a plot of the percentage (%) BChE unbound to Con A vs.age (yr) for both AD and controls. This figures shows that there is norelationship between BChE glycosylation and age. Thus disease status isthe only correlate.

[0026]FIG. 4 is a three dimensional plot of the total BChE, C/W ratioand the percentage (%) BChE unbound to Con A showing complete separationof the AD and control groups.

BEST MODE FOR CARRYING OUT THE INVENTION

[0027] AChE, acetylcholinesterase; butyrylcholinesterase (BuChE) ChE,cholinesterase; Aβ, amylid β protein; AD, Alzheimer's disease; DP,diffuse plaques; ND, other neurological diseases; PMI, post morteminterval; PBS, phosphate-saline buffer; TB, Tris buffer; TSB,Tris-saline buffer; SS, salt-soluble supernatant; TS, TritonX-100-soluble supernatant; AF, amphiphilic fraction; HF, hydrophilicfraction; G^(a), globular amphiphilic isoform; G^(na), globularnon-amphiphilic isoform; and agglutinins from Canavalia ensiformis(Concanavalin A), Con A; Triticum vulgaris (wheat germ), WGA; Ricinuscommunis, RCA₁₂₀ ; Lens culinaris, LCA; Dolichus biflorus, DBA; Ulexeuropaeus, UEA_(l) ; Glycine max, SBA; and Arachis hypogaea, PNA.

[0028] Immobilised lectins (Con A- and LCA-Sepharose, WGA-, RCA₁₂₀-,DBA-, UEA_(l); SBA and PNA-agarose), phenylagarose, bovine livercatalase, E. coli alkaline phosphatase, polyoxyethylene-10-oleyl ether(Brij 97), Triton X-100, tetraisopropyl pyrophosphoramide (iso-OMPA),1,5-bis(4-allydimethyl-ammoniumphenyl)-pentan-3-1 dibromide (BW284c51),acetylthiocholine iodide and 5,5′-dithio-bis-2-nitrobenzoic acid (DTNB)were all obtained from Sigma-Aldrich Pty. Ltd. (Seven Hills, NSW,Australia). Sepharose CL-4B was purchased from Pharmacia Biotech AB(Uppsala, Sweden). TABLE 1 Binding of CSF BChE to Various Lectins % BChEUnbound to Lectin Lectin Controls AD DNAT OND Con A  3.0 ± 0.6  6.4 ±0.7*  2.0 ± 0.7  2.4 ± 0.9 LCA 57.4 ± 6.2 29.4 ± 2.2 41.0 ± 1.5 39.6 ±3.1 WGA 10.4 ± 3.7  6.2 ± 0.8  4.6 ± 0.9  4.4 ± 1.0 RCA 39.7 ± 4.0 38.5± 2.7 32.0 ± 9.4 42.3 ± 3.7 DBA 98.0 ± 1.2 93.8 ± 1.9 100.0 ± 0.0   83.8± 10.5 PNA 86.6 ± 6.1 93.3 ± 1.5 92.7 ± 1.5 95.8 ± 4.3 SBA 83.7 ± 2.186.9 ± 1.5 96.0 ± 1.0 91.0 ± 2.4 UEA_(l) 92.1 ± 1.6 90.4 ± 1.7 91.3 ±0.3 93.0 ± 3.0

[0029] The following Examples relate to experiments conducted withacetylcholinesterase (AchE). One skilled in the art would readily beable extrapolate from the following Examples to make a diagnostic testfor Alzheimer's Disease comprising the detection ofbutyrylcholinesterase (BchE) with an altered glycosylation pattern

EXAMPLE 1 Lectin Binding AChE Experiments in AD Patients

[0030] Lumbar or ventricular CSF was obtained post mortem; 18 controlswith no clinical or pathological dementia and no clinical orpathological dementia and no evidence of brain pathology, 27 cases ofAD, 7 cases of dementia non-AD type (DNAT, 5 frontal lobe dementia, 1Lewy body dementia/Parkinson's disease and 1 multi-infarctdementia/congophilic amyloid angiolpathy), and 6 cases of otherneurological disorders (ND, 4 Huntington's disease, 1 schizophrenia and1 corticobasal degeneration). The average age in the control group was68±4 years, there were 10 females and 8 males and the PMI was 40±6. Inthe AD group the age was 81±2 years, there were 13 female and 14 malesand the PMI was 35±6. In the ND group the age was 65±6, there were 3females and 3 males and the PMI was 45±12. In the DNAT group the age was76±3, there were 4 female and 3 males and the PMI was 34±11. Samples ofCSF were stored at −70° C. and centrifuged at 1,000× g for 15 min priorto analysis. AChE activity was assayed at 22° C. by a modifiedmicroassay of the Ellman method (Ellman et al. 1961). Aliquots (0.3 ml)were mixed with 0.1 ml of Sepharose 4B in PBS (control), Concanavalin A(Con A) or wheat germ agglutinin (WGA, Triticum vulgaris) immobilised onSepharose. The enzyme-lectin mixture was incubated overnight at 4° C.,and then centrifuged (1,000× g, 15 min). AChE activity was assayed inthe supernatant fractions. Data were analysed using a Student's t-test.

[0031] The total AChE values in ventricular CSF samples of subjects=>60yrs old were significantly lower in the AD group (6.98±0.82 nmol/min/ml)than in controls (17.24±4.28 nmol/min/ml; P<0.001). However, as reportedpreviously, (Appleyard et al., 1983), the large overlap (40%) betweenthe data prevents the use of total AChE as a significant diagnosticmarker.

[0032] However, lectin-binding analysis revealed a significantdifference between the AD group and controls. Approximately 75-95% ofthe AChE in the CSFs bound to Con A or WGA. A ratio (C/W ratio) wasdefined as AChE unbound to Con A divided by AChE unbound to WGA. Themean C/W ratio for the AD group was significantly different fromcontrols (FIG. 1). Of the 27 CSFs from confirmed AD, 21 samples had aC/W ratio>0.95. All 18 control samples had C/W<0.95, without significantdifferences between younger (n=5, C/W=0.37±0.10) and older subjects(n=6, 0.38±0.08) samples. No correlation in C/W ratio was noted withpost mortem interval (PMI). The data are represented graphically in FIG.1.

[0033] The data indicate that lectin-binding analysis of CSF AChE couldprovide a diagnostic test for AD which is 80% sensitive and 97%specific. Thus it was proposed that differences observed in theglycosylation pattern of AChE in CSF may be useful as an ante mortemdiagnostic marker for AD, particularly when used in combination withmeasurement of other biochemical markers.

EXAMPLE 2 Human Brain and CSF Samples for AChE Experiements

[0034] Ventricular and lumbar CSF, frontal cortical and cerebellarsamples were obtained post mortem and stored at −80° C. Three non-ADgroups of samples were defined, 1) controls with no clinical orpathological features of dementia (n=18), 2) individuals who showed noclinical signs of dementia but who were found to have a moderate numberof non-neuritic Ab-immunoreactive diffuse plaques (DP), but no evidenceof neocortical neurofibrillary changes (n=6), and 3) individuals withvarious neurological diseases (ND) containing 7 cases of non-AD typedementia (5 frontal lobe dementia, 1 Lewy body dementia and 1 vasculardementia) and 7 cases of other neurological disorders (4 Huntington'sdisease, 1 Parkinson's disease, 1 schizophrenia and 1 corticobasaldegeneration). Cases of AD were selected on the basis of their clinicalhistory of dementia and neuropathological CERAD diagnosis (Mirra et al.,1994). All the CSF samples included in the AD and ND groups wereventricular and only 5 control and 1 DP CSF samples (from a total of 18and 6 subjects, respectively) were taken by lumbar puncture.Immunohistochemical examination of the cerebellar samples showed that,unlike the frontal cortex, none of the AD tissue possessed compactneuritic amyloid plaque deposition (data not shown), consistent withprevious studies (Mann etal., 1996).

[0035] It has been shown (Grass) et al., 1982; Fishman et al., 1986;Sáez-Valero etal., 1993) that for a post mortem interval (PMI) greaterthan 72 hr, storage at −20° C. or repeated cycles of freeze-thawingcaused degradation of AChE, which confounded glycosylation analysis.Therefore, only samples with a PMI of less than 72 hr (PMI=36±4 hr) wereused. There was no significant difference in PMI between each group ofsamples.

[0036] Preparation of Samples and Extraction of AChE

[0037] Samples of CSF were thawed slowly at 4° C. and then centrifugedat 1,000× g for 15 min prior to use. Small pieces (0.5 g) of frontalcortex and cerebellum were thawed slowly at 4° C., weighed andhomogenised (10% w/v) in ice-cold Tris-saline buffer (TSB; 50 mMTris-HCl, 1 M NaCl, and 50 mM MgCl₂, pH 7.4) containing a cocktail ofproteinase inhibitors (Silman et al., 1978). Tissues were homogenisedwith a glass/Teflon homogeniser and then sonicated with 10-15 bursts at50% intermittency at setting 4 using a Branson sonifier. The suspensionwas centrifuged at 100,000× g at 4° C. in a Beckman L8-80Multracentrifuge using a 70.1 Ti rotor for 1 hr to recover a salt-solubleChE fraction (SS). The pellet was re-extracted with an equal volume ofTSB containing 1% (w/v) Triton X-100, and the suspension centrifuged at100,000× g at 4° C. for 1 hr to obtain a Triton X-100-soluble ChEfraction (TS). This double-extraction method recovered 80-90% of thetotal ChE activity (SaezValero et al., 1993; Moral-Naranjo et al.,1996).

[0038] AChE Assay and Protein Determination

[0039] AChE activity was determined by a modified microassay method ofEllman (Sáez-Valero et al., 1993). One unit of AChE activity was definedas the number of nmoles of acetylthiocholine hydrolysed per min at 22°C. Protein concentrations were determined using the bicinchoninic acidmethod with bovine serum albumin as standard (Smith et al., 1985).

[0040] Hydrophobic Interaction Chromatography on Phenyl-agarose

[0041] Amphiphilic AChE forms were separated from hydrophilic forms byhydrophobic interaction chromatography on phenyl-agarose as previouslydescribed (Sáez-Valero et al., 1993). CSF (10 ml-pooled from foursamples obtained from four different subjects) was applied to a column(10×1 cm) of phenyl-agarose. A hydrophilic fraction (HF) containinghydrophilic isoforms of AChE was eluted with 30 ml of TSB, and then anamphiphilic fraction (AF) containing bound amphiphilic isoforms waseluted with 50 mM Tris-HCl (TB, pH 7.4) containing 2% (w/v) TritonX-100. Peak fractions with high AChE activity were pooled andconcentrated using Ultrafree-4 Centrifugal Filter Device Biomax 10 kDaconcentrators (Millipore Corporation, Bedford, Mass., USA).

[0042] Sedimentation Analysis

[0043] Molecular isoforms of AChE were analysed by ultracentrifugationat 150,000× g in a continuous sucrose gradient (5-20% w/v) for 18 hr at4° C. in a Beckman SW40 rotor. The gradients contained 10 ml of 50 mMTris-HCl (pH 7.4) containing 0.5 M NaCl, 50 mM MgCl₂ and 0.5% (w/v) Brij97. Approximately 40 fractions were collected from the bottom of eachtube. Enzymes of known sedimentation coefficient, bovine liver catalase(11.4S, S_(20,w) Svedberg Units) and E. coli alkaline phosphatase (6.1S)were used in the gradients to determine the approximate sedimentationcoefficients of AChE isoforms. A ratio of AChE species G_(4/)(G₂+G₁),that reflected the proportion of G₄ molecules (G₄ ^(na)+G₄ ^(a)) versusboth light globular AChE isoforms, G₂ ^(a) and G₁ ^(a) was defined.Estimation of the relative proportions of each molecular form of AChEwas performed by adding the activities under each peak (G₄ or G₂+G₁) andcalculating the relative percentages (recovery>95%).

[0044] Lectin-binding Analysis of AChE

[0045] Samples (0.3 ml) were added to 0.1 ml (hydrated volume) ofSepharose 4B (control), Con A, WGA, RCA₁₂₀, LCA, DBA, UEA_(l), SBA orPNA immobilised in agarose or Sepharose. The enzyme-lectin mixture wasincubated overnight at 4° C. with gentle mixing. Bound and free AChEwere separated by centrifugation at 1000× g for 15 min at 4° C. in aBeckman J2-21 M/E centrifuge using a JA-20 rotor, and the unbound AChEwas assayed in the supernatant fraction. Percentage of unbound AChE inthe lectin incubation was calculated as (AChE unbound to lectin/AChEunbound to Sepharose)×100. The C/W ratio was calculated according to theformula, AChE activity unbound in the Con A incubation divided by theAChE activity unbound in the WGA incubation. It was observed that thisratio detects a specific alteration in AChE glycosylation that occurs inAD CSF.

[0046] Lectin Binding of CSF AChE

[0047] To examine the glycosylation of AChE, CSF samples from 18controls and 30 cases of AD were incubated with different immobilisedlectins, which recognise different sugars. AChE bound strongly to Con A,WGA and LCA but weakly to RCA₁₂₀, PNA, DBA, UEA, and SBA (Table 1),suggesting that most of the enzyme was devoid of terminal galactose,terminal N-acetyl-galactosamine or fucose.

[0048] There was a small but significant difference in the binding ofAChE to Con A and WGA between the AD group and controls (Table 1). Asthe percentage of AChE unbound in the AD CSF was increased for Con A anddecreased for WGA, a ratio (C/W=[% AChE that does not bind to Con A]/[%AChE that does not bind to WGA]) was defined, which provided greaterdiscrimination between the two groups (Table 1). Using this method, itwas found that the mean C/W ratio for the AD group was significantlygreater than for the other control groups, including cases with diffuseplaques (non-demented, DP), and patients with other neurological andneuropsychiatric diseases (ND) (FIG. 2), consistent with the resultsshown in Example 1. Of the 30 CSF samples from confirmed AD cases, 24samples were above a cut-off value of C/W=0.95 (FIG. 2). Only one samplefrom 18 controls, one out of 6 samples from cases with diffuse plaques,and one out of 14 samples from the other neurological diseases group, afrontal lobe dementia case, were above this value. The 6 AD samples withC/W ratios lower than 0.95 had C/W ratios>0.60, a value higher than theC/W mean of the non-AD groups (control=0.53±0.1; DP=0.46±0.2;ND=0.53±0.1).

[0049] No correlation could be found between the C/W ratio and the PMIthat could suggest that different C/W ratio in the AD group was due todifferences in PMI. Furthermore, there was no significant difference inthe PMI between the AD (33±6 hr) and non-AD samples (40±6 hr).

[0050] CSF samples were additionally analysed for total AChE activity(FIG. 2). As previously reported (Appleyard et al., 1983; Atack et al.,1988), the CSF from patients with AD had significantly lower AChEactivity (6.5±0.8 U/ml) than controls (15.8±2.9 U/ml) or patients withother diseases (12.4±2.4 U/ml). However, the C/W ratio was a morereliable index of clinical status than the total level of AChE activityin the CSF (FIG. 2).

[0051] AChE Isoforms in CSF

[0052] To determine whether the alteration in glycosylation was due tochanges in a specific isoform of AChE, CSF samples were analysed byhydrophobic interaction chromatography to separate amphiphilic (G^(a))and hydrophilic species (G^(na)) (FIG. 3), and by sucrose densitygradient centrifugation in 0.5% (w/v) Brij 97 to separate individualmolecular weight isoforms (G₄,G₂ and G₁) (FIG. 3). A decrease in theproportion of G₄, AChE in AD CSF compared to controls (FIG. 4, toppanels) was observed. The ratio of (G₄,/(G₂+G₁) was significantly(P<0.01) higher in controls (1.80±0.12; n=4) than in AD cases(1.16±0.12; n=4). To separate hydrophilic isoforms from amphiphilicisoforms, CSF was fractionated by hydrophobic interaction chromatographyon phenyl-agarose (FIG. 3). A smaller percentage of AChE in the normalCSF bound to phenyl agarose (12±3%, n=4) than in the AD CSF (38±4%, n=4;P<0.001). Sedimentation analysis of the unbound hydrophilic fraction(HF) showed a main peak of 10.8S, consistent with a hydrophilictetrameric (G₄ ^(na)) isoform (Atack et al., 1987), as well as a smallamount of lighter AChE isoforms, 5.1S dimers and 4.3S monomers (FIG. 4).The bound amphiphilic fraction from the phenyl-agarose column containeda minor peak of 9.0-9.5S (probably an amphiphilic tetramer, G₄ ^(a) anda major peak of amphiphilic globular dimer (G₂ ^(a), 4.2S) and monomer(G₁ ^(a), 3.1S). The level of the amphiphilic light isoforms was greaterin the AD CSF than in controls (FIG. 4).

[0053] Glycosylation of Individual AChE Isoforms in CSF

[0054] Incubation of the HF and AF with immobilised Con A and WGA showedthat there was an increase in the C/W ratio in AD CSF, and that the highCIW ratio was associated with an amphiphilic fraction containing dimersand monomers (FIG. 4). The data indicate that the contribution of G₂ andG₁ AChE in AD CSF was mainly responsible for the increased C/W ratio oftotal AChE in the AD CSF.

[0055] Levels of AChE in Frontal Cortex and Cerebellum

[0056] To determine whether the changes in AChE glycosylation reflect achange in the expression or glycosylation of brain AChE isoforms, thelevels of AChE activity in samples of frontal cortex and cerebellum wereexamined. Samples were homogenised with salt and Triton X-100 to extractsoluble and membrane-bound AChE isoforms, and then the AChE activitydetermined in both fractions (Table 2). The frontal cortex samples fromAD patients had significantly less AChE activity in the TritonX-100-soluble (TS) fraction (˜40%), with no difference in levels in thesalt-soluble (SS) fraction compared with controls (Table 3). The resultsare consistent with previous studies that indicate that the major G₄isoform is decreased only in the TS fraction (Younkin et al., 1986; Seiket al., 1990). A small but significant decrease (˜15%) in the proteincontent of the TS fraction of both AD and ND groups was also observed.The level of AChE in the frontal cortex samples of the ND group wassignificantly different from controls in both the SS and TS fraction(Table 2). However, as the ND group was heterogeneous (2 frontal lobedementia, 1 Huntington's disease and 1 Parkinson's disease), thesignificance of changes in AChE levels is unclear. Levels of AChE incerebellum were also significantly decreased in the TS fraction from theAD group (Table 2).

[0057] Glycosylation of AChE in Frontal Cortex and Cerebellar

[0058] To determine whether different glycosylation pattern of AChE inAD CSF is also present in the AD brain, the glycosylation of brain AChEwas examined by lectin binding. Homogenates from frontal cortex andcerebellum were incubated with immobilised Con A or WGA and the amountof activity unbound was calculated. In the AD frontal cortex, the % AChEactivity that did not bind to Con A or WGA was significantly differentfrom controls (Table 3). Similar to the CSF AChE, the C/W ratio offrontal cortex AChE was greater in AD than in non-AD samples (Table 3).This increase was due to a large increase in the amount of AChE that didnot bind to Con A, and was in spite of an increase in the amount of AChEthat did not bind to WGA (Table 3). There was no increase in the C/Wratio in the DP and ND group (Table 3). No difference in lectin bindingwas observed between AD and non-AD groups in the cerebellar fractions(Table 3.)

[0059] AChE Isoforms in Frontal Cortex and Cerebellum

[0060] To determine the cause of the altered glycosylation in AD brain,the pattern of AChE isoforms in the frontal cortex and cerebellum wasexamined. Equal volumes of SS and ST supernatants (total AChE activity)were pooled and then analysed by sucrose density gradient sedimentationwith 0.5% (w/v) Brij 97 to separate the major AChE isoforms (FIG. 5).Based on their sedimentation coefficients (Atack et al., 1986; Massouliéet al., 1982) it was possible to identify hydrophilic (G₄ ^(na),10.7±0.1S) and amphiphilic tetramers (G₄ ^(a), 8.6±0.1S) amphiphilicdimers (G₂ ^(a), 4.7±0.1S) and monomers (G₁ ^(a), 3.0±0.1S) of AChE(FIG. 6). There were no differences in the sedimentation coefficient (S)of individual isoforms from each group. Due to the overlap in thesedimentation coefficients between AChE G₄ ^(na) and G₄ ^(a), it was notpossible to separate these isoforms completely (FIG. 5). However, thecontribution of G₄ ^(a) was greater than G₄ ^(na). Asymmetric (A₁₂) AChEisoforms were identified in trace amounts (2-5%) in some of thefractions.

[0061] A significant decrease in G₄, (40% of the mean control value,P<0.001) and in G₂+G₁ AChE (60% of the mean control value, P=0.002) wasdetected in the fractions from AD frontal cortex. This change in therelative proportion of AChE isoforms was reflected in the G₄/(G₂+G₁)ratio, which was significantly lower in the AD samples (Table 3).Interestingly, a similar and statistically significant decrease wasfound in the G₄/(G₂+G₁) ratio for the DP subjects. This change in ratiowas due to a 25% increase in the level of G₂+G₁ and a small decrease(10%) in G₄ AChE, although neither change on its own was statisticallysignificant. No variation in AChE G₄/(G₂+G₁) was found in the ADcerebellum (Table 3), despite a statistically significant decrease (40%)in AChE in the TS fraction (Table 2) and in the total level of G₄ AChE(G₄ in controls=380±40 U/ml, G₄ in ADs=195±70 U/ml; P=0.008).

[0062] Glycosylation of Individual AChE Isoforms in Frontal Cortex andCerebellum

[0063] Since it was found that the ratio of AChE was altered in thefrontal cortex of AD patients, steps were taken to ascertain whether theincrease in the C/W ratio of brain AChE was due to a change inglycosylation or in the expression of a specific isoform of AChE.Individual AChE isoforms were separated by sucrose gradientcentrifugation and then fractions from the G₄ or G₂+G₁ peaks werepooled, dialysed against TSB-Triton X-100 buffer and concentrated byultrafiltration. AChE isoforms were then assayed by lectin binding and aC/W ratio calculated for each isoform (FIG. 5).

[0064] No differences were observed in the C/W ratio of G₄, AChE betweenthe AD and non-AD groups (FIG. 5). However, in all frontal cortexsamples the G₂+G₁ fraction possessed C/W ratios>1.00, demonstrating thatG₂ or G₁ AChE is glycosylated differently from the G₄ isoform. Moreover,the C/W ratio for G₂+G₁ AChE was higher in the AD group than controls orDP. Similarly, the C/W ratio of the amphiphilic fraction from CSF(containing predominantly G₂+G₁ AChE) was higher in the AD group than incontrols (FIG. 3). There was no correlation between the G₄/(G₂+G₁) ratioand the C/W ratio in the DP group in frontal cortex. In the cerebellum,no differences were observed in the C/W ratios of G₄ AChE or G₂+G₁ AChEbetween AD and non-AD groups (FIG. 4). The G₂+G₁ fractions, from both ADand non-AD cerebellar groups, had a C/W<0.50, in contrast to the samefraction from frontal cortex (C/W>1.00) indicating differences in thepattern of glycosylation of G₂+G₁ AChE between both brain areas.

[0065] This example shows that AChE is glycosylated differently in thefrontal cortex and CSF of AD patients compared with AChE from non-ADgroups including patients with non AD-type dementias. This difference inglycosylation is due to an increase in the proportion of differentiallyglycosylated amphiphilic dimeric and monomeric AChE in the AD samples.The results suggest that the abnormally glycosylated AChE in AD CSF maybe derived from the brain as a similar difference in glycosylation wasalso found in the frontal cortex of AD patients. TABLE 1 Lectin-bindingof AChE in CSF. AChE unbound (%) Lectin Control AD Con A  5.5 ± 0.8 10.0± 1.1^(b) WGA 11.3 ± 1.7  7.0 ± 0.6^(b) Con A/WGA 0.53 ± 0.1 1.37 ±0.1^(a) (C/W) LCA 17.2 ± 4.2 15.0 ± 1.3 RCA₁₂₀ 74.1 ± 3.4 70.8 ± 2.7 SBA83.0 ± 2.1 82.2 ± 1.9 UEA_(l) 91.6 ± 2.2 87.6 ± 1.9 PNA 92.4 ± 1.7 92.3± 1.4 DBA 98.9 ± 0.8 95.8 ± 1.7

[0066] All the CSFs were taken post mortem and the diagnosis confirmedby pathological examination. CSF from normal subjects (Control group:n=18; 67±4 years at death; 11 Females/7 Males) and AD patients (ADgroup: n=30; 79±2 y; 15F/15M) were incubated either with an equal volumeof the different immobilized lectins, and then centrifuged. AChE wasassayed in the supernatant fractions. The data represent the means±SEM.TABLE 2 AChE activity and protein levels in human frontal cortex andcerebellum AChE activity Protein (U/ml) (mg/ml) Group/Source SS TS SS TSControl Frontal Cortex 3.7 ± 0.4 15.1 ± 1.5 2.1 ± 0.1 2.4 ± 0.1 (n = 11;63 ± 5 y; 7F/4M) Cerebellum  64 ± 6  264 ± 25 2.5 ± 0.1 1.9 ± 0.1 (n =7; 66 ± 5 y; 4F/3M) DP Frontal Cortex 5.5 ± 0.9 12.7 ± 1.7 2.1 ± 0.1 2.2± 0.1 (n = 6; 81 ± 2 y; 4F/2M) Cerebellum  49 ± 8  182 ± 46 2.6 ± 0.11.9 ± 0.1 (n = 5; 81 ± 3 y; 3F/2M) ND Frontal Cortex 5.4 ± 0.6^(a)  9.3± 1.7^(b) 2.1 ± 0.2 2.0 ± 0.1^(b) (n = 4; 67 ± 9 y; 2F/2M) Cerebellum 45 ± 8  160 ± 50 2.7 ± 0.2 2.3 ± 0.2 (n = 2; 78 ± 14 y; 1F/1M) ADFrontal Cortex 3.7 ± 0.3  9.0 ± 0.9^(a) 2.1 ± 0.1 2.1 ± 0.1^(a) (n = 14;73 ± 3 y; 8F/6M) Cerebellum  48 ± 12 160 ± 28^(b) 2.6 ± 0.1 2.0 ± 0.1 (n= 7; 73 ± 6 y; 5F/2M)

[0067] Tissue from frontal cortex or cerebellum was homogenized andsalt-soluble (SS) and Triton X-100-soluble (TS) extracts obtained. Theextracts were then assayed for AChE and protein. DP=non-dementedsubjects with diffuse plaques; ND=individuals with other neurologicaldiseases and dementias of non-AD type; AD=individuals with Alzheimer'sdisease. F=female; M=male; y=age in years. Values are means±SEM. TABLE 3Lectin binding and AChE isoforms in frontal cortex and cerebellum Lectinbinding AChE AChE unbond to unbound AChE ratio Group/Source Con A (%) toWGA (%) C/W G₄/ (G₂+G₁) Control Frontal Cortex  6.9 ± 0.8 12.3 ± 1.20.56 ± 0.03 1.90 ± 0.14 (n = 11; 63 ± 5 y; 7F/4M) Cerebellum  1.8 ± 0.110.7 ± 0.9 0.18 ± 0.02 3.02 ± 0.14 (n = 7; 66 ± 5 y; 4F/3M) DP FrontalCortex  7.4 ± 0.8 15.0 ± 1.0 0.50 ± 0.06 1.32 ± 0.12^(b) (n = 6; 81 ± 2y; 4F/2M) Cerebellum  2.9 ± 0.7 12.2 ± 1.3 0.23 ± 0.05 2.18 ± 0.33 (n =5; 81 ± 3 y; 3F/2M) ND Frontal Cortex  7.0 ± 0.6 13.2 ± 1.2 0.47 ± 0.052.61 ± 0.73 (n = 4; 67 ± 9 y; 2F/2M) Cerebellum  1.8 ± 0.2 10.1 ± 0.30.21 ± 0.10 2.50 ± 0.70 (n = 2; 78 ± 14 y; 1F/1M) AD Frontal Cortex 13.1± 1.3^(a) 19.7 ± 1.4^(a) 0.66 ± 0.03^(b) 1.34 ± 0.18^(b) (n = 14; 73 ± 3y; 8F/6M) Cerebellum  2.4 ± 0.3 13.5 ± 2.3 0.19 ± 0.02 2.33 ± 0.49 (n =7; 73 ± 6 y; 5F/2M)

[0068] SS and TS fractions from frontal cortex and cerebellum werepooled in equal volumes and then analyzed by lectin binding usingimmobilized Con A and WGA. The C/W ratio was calculated as defined inTable 2. Aliquots of the supernatants (SS+TS) were also analyzed bysucrose density gradient sedimentation to identify AChE isoforms. Valuesare means±SEM.

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What is claimed is:
 1. A method for the diagnosis of Alzheimer's diseasein a patient, comprising the steps of: (1) providing a sample of anappropriate body fluid from said patient, and (2) detecting the presenceof butyrylcholinesterase with an altered glycosylation pattern in saidsample.
 2. The method of claim 1 wherein the relative proportions ofbutyrylcholinesterase with a specific glycosylation pattern to the totalbutyrylcholinesterase are measured.
 3. The method of claim 2 wherein therelative proportions of butyrylcholinesterase are measured using alectin-binding analysis.
 4. The method of claim 3 wherein thelectin-binding analysis includes measurement of butyrylcholinesterasebinding to Concanavalin A.
 5. The method of claim 4 wherein activity ofunbound butyrylcholinesterase is determined.
 6. The method of claim 5further comprising the steps of: (1) measuring the proportion ofacetylcholinesterase binding to Concanavalin A, (2) measuring theproportion of acetylcholinesterase binding to wheat germ agglutinin, (3)determining the ratio of acetylcholinesterase unbound to Concanavalin Ato acetylcholinesterase unbound to wheat germ agglutinin, and (4)comparing the ratio with the relative proportion ofbutyrylcholinesterase unbound to Concanavalin A.
 7. The method of claim6 wherein said ratio is above about 0.95 in Alzheimer's diseasepatients.
 8. The method of claim 6 wherein the totalbutyrylcholinesterase activity is determined.
 9. The method of claim 8wherein the proportion of butyrylcholinesterase unbound to ConcanavalinA is plotted against the total butyrylcholinesterase activity, and theratio of acetylcholinesterase unbound to Concanavalin A toacetylcholinesterase unbound to wheat germ agglutinin.
 10. The method ofclaim 1 wherein a monoclonal antibody is used to detect the presence ofbutyrylcholinesterase with an altered glycosylation pattern.
 11. Themethod of claim 1 wherein an abnormal isoform of butyrylcholinesterasewith an altered glycosylation pattern is detected.
 12. The method ofclaim 1 wherein said sample is cerebrospinal fluid, blood or bloodplasma.
 13. The method of claim 12 wherein said blood or blood plasma isprepared from the blood for analysis.
 14. The method of claim 13 whereinsaid body fluid is blood plasma and butyrylcholinesterase is removedprior to analysis for the presence of acetylcholinesterase with analtered glycosylation pattern.
 15. An abnormal isoform ofbutyrylcholinesterase with an altered glycosylation pattern and a lesseraffinity for Concanavalin A and a greater affinity for wheat germagglutinin than butyrylcholinesterase with an unaltered glycosylationpattern.
 16. An abnormal isoform of butyrylcholinesterase with analtered glycosylation pattern and a lesser affinity for Concanavalin Aand a greater affinity for wheat germ agglutinin thanbutyrylcholinesterase with an altered glycosylation pattern.
 17. Themethod of claim 8 wherein the ratio of butyrylcholinesterase unbound toConcanavalin A relative to the total butyrylcholinesterase is at leastabout eight percent.
 18. The method of claim 15 wherein said body fluidis blood plasma and butyrylcholinesterase is inactivated prior toanalysis for the presence of acetylcholinesterase with an alteredglycosylation pattern.